Hemolytic Disease of the Newborn

What is hemolytic disease of the newborn (HDN)?

Hemolytic Disease of the Newborn is also called erythroblastosis fetalis. This
condition occurs when there is an incompatibility between the blood types of the mother
and baby
• "Hemolytic" means breaking down of red blood cells.
• "Erythroblastosis" refers to making of immature red blood cells.
"Fetalis" refers to fetus.

What causes hemolytic disease of the newborn (HDN)?

HDN most frequently occurs when an Rh negative mother has a baby with an Rh
positive father. When the baby's Rh factor is positive, like the father's, problems can
develop if the baby's red blood cells cross to the Rh negative mother. This usually
happens at delivery when the placenta detaches. However, it may also happen anytime
blood cells of the two circulations mix, such as during a miscarriage or abortion, with a
fall, or during an invasive prenatal testing procedure (i.e., an amniocentesis or chorionic
villus sampling).
The mother's immune system sees the baby's Rh positive red blood cells as "foreign."
Just as when bacteria invade the body, the immune system responds by developing
antibodies to fight and destroy these foreign cells. The mother's immune system then
keeps the antibodies in case the foreign cells appear again, even in a future pregnancy.
The mother is now "Rh sensitized."
Although it is not as common, a similar problem of incompatibility may happen between
the blood types (A, B, O, AB) of the mother and baby in the following situations:

Mother’s blood type O A B

Baby’s blood type A or B B A

In a first pregnancy, Rh sensitization is not likely. Usually it only becomes a problem in a

future pregnancy with another Rh positive baby. During that pregnancy, the mother's
antibodies cross the placenta to fight the Rh positive cells in the baby's body. As the
antibodies destroy the red blood cells, the baby can become sick. This is called
erythroblastosis fetalis during pregnancy. In the newborn, the condition is called
hemolytic disease of the newborn.

Who is affected by hemolytic disease of the newborn?

Babies affected by HDN are usually in a mother's second or higher pregnancy, after she
has become sensitized with a first baby. HDN due to Rh incompatibility is about three
times more likely in Caucasian babies than African-American babies.